Pharmacies surviving ‘on the backs of people who don’t know any better’

CMs in half an orange

Criticism of the availability of non-evidence-based complementary medicines in pharmacy is emerging as one of several themes in the written submissions to the King Review.

To date the Review has received 37 written submissions available on the Health Department’s website.

The Review’s Discussion Paper noted that some consumers are concerned pharmacists may compromise on QUM and professional advice due to perceived financial pressures to up-sell by offering medicines which may not be necessary.

“It was also claimed that many complementary products do not have evidence-based health benefits and as such, the sale of these products in a pharmacy setting may misinform consumers of their effectiveness and undermine the professional integrity of community pharmacists,” the panellists noted.

Several submission authors raised this point. Consumer Andrew Woodman said he was prompted to make a submission to the Review after reading a Reddit comment thread in which a Redditor said he had been “swindled by a pharmacist” when he was sold homoepathic melatonin.

“It’s clear that this person was at the very least confused about a ‘supplemental’ treatment sold in a pharmacy and if he had not carefully read the label would not have ended up purchasing the  medicine he needed,” Woodman wrote.

“Walk into any pharmacy and you will see shelves upon shelves of vitamins, homeopathic remedies and other supplements. These are all almost universally useless in the vast majority of cases, and I’m sure the pharmacists know this.

“It looks to me that pharmacists are propping up their businesses on the backs of people who don’t know any better. I’m sure the profit margins on this snake oil is much higher than PBS listed medications.”

Consultant physician and consultant psychiatrist John Buchanan said that it is extremely confusing for patients if non-evidence-based “therapies” are sold alongside prescription medicines.

“My understanding is that the Australian community spends as much on ‘supplements and vitamins’ as it does on prescription medicines,” Dr Buchanan wrote.

“It would appear that the vast majority of these ‘supplements and vitamins’ are not of any demonstrated clinical benefit.

“From a medical point of view, the advertising of them is in fact laughable – so often one hears ‘preparation X may support the function of your thyroid/prostate/liver/whatever’.

“As well as the waste of money, it is of concern to many medical practitioners that patients use such supplements and vitamins, etc. in an attempt to self-medicate, which is often an unhelpful step, because it means that they avoid presenting for a proper medical assessment of whatever their difficulty is or symptoms are.”

And Geoff Sloan, a member of National Seniors Australia’s NT Policy Advisory Group, said he had in the past raised concerns with NSA about the marketing of supplements to its members; due to this concern he researched the efficacy of supplements and came to the conclusion that for most people they produce no advantage or discernible effect.

“For people with defined incomes, as most retired people have, expending significant amounts of that income on a product or products that provide little or no benefit is undesirable,” he wrote in his submission.

As an example he detailed a recent trip to a pharmacy to fill a cholesterol-lowering script, when he was asked “for the first time ever in a pharmacy” whether he suffered cramps or muscle pain at night. He said yes and without further investigation (Sloan is a keen cyclist who occasionally neglected hydration) was recommended a supplement.

“Even though I held a well-researched belief I felt under considerable pressure to purchase the item. I did not,” Sloan wrote.

“However, I feel that many people with less well established attitudes and opinion about supplements would have purchased the item, and once purchased would have become supportive of its use.

“I believe that this method is not confined to pharmacies in my town and feel that the practice could produce more harm than good, in that an expense is being incurred for a product of dubious value when the money could be spent more effectively on good advice and a better diet.”

But Dave Rees, a community pharmacy owner in Condobolin, was keen to help pharmacists access information about the evidence base for CMs, rather than simply condemning the entire sector outright.

“Trying to evaluate all the myriad of CAMs on the market and their evidence base can be overwhelming for a pharmacist with an already full work load,” Rees wrote in his submission.
“A system of accreditation (whether by the TGA or a separate body) for CAMs would be very valuable for pharmacy, as well as the wider health system.
“An idea I heard floated somewhere else envisaged a green tick logo, similar to the Heart Foundation tick for healthy foods, could be employed for products that are marketed only with claims that have a minimum level of evidence behind them.
“Details such as the minimum required level of evidence would need to be determined.
“This would  give a clear indication what has a place in community pharmacy (and legitimate healthcare) and what belongs in the realm of pseudo-scientific quackery.”

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